February 24, 2014

A computerized safety checklist that automatically pulls information from patients' electronic medical records was associated with a threefold drop in rates of one serious type of hospital-acquired infection, according to a study by researchers at the Stanford University School of Medicine and Lucile Packard Children's Hospital Stanford.

The study, conducted in the hospital's pediatric intensive care unit, targeted bloodstream infections that begin in central lines - catheters inserted into major veins. The infections are a preventable cause of illness and death, and hospitals across the country are working to reduce their frequency.

The automated checklist, and a dashboard-style interface used to interact with it, made it fast and easy for caregivers to follow national guidelines for keeping patients' central lines infection-free. The new system combed through data in the electronic medical record and pushed alerts to physicians and nurses when a patient's central line was due for care. During the study, the rate of central line infections in the hospital's pediatric intensive care unit dropped from 2.6 to 0.7 per 1,000 days of central line use.

The findings will be published online Feb. 23 in Pediatrics.

"Electronic medical records are data-rich and information-poor," said Natalie Pageler, MD, the study's lead author. Often, the data in electronic medical records is cumbersome for caregivers to use in real time, but the study showed a way to change that, said Pageler, who is a critical care medicine specialist at the hospital and a clinical associate professor of pediatrics. "Our new tool lets physicians focus on taking care of the patient while automating some of the background safety checks."

Central lines have many uses, such as administering long-term antibiotics or chemotherapy and providing access to the bloodstream in patients who need kidney dialysis or frequent blood draws. The Institute of Medicine's 1999 report on medical errors, To Err is Human, identified central line infections as a key target for reducing harm in health care. Approximately 40 percent of patients in the pediatric intensive care unit have central lines at some point during their hospital stays.

The research team collaborated with engineers from HP Labs to program the checklist and build a dashboard interface that displayed real-time alerts on a large LCD screen in the nurses' station. Alerts - shown as red, yellow or green dots beside patients' names - were generated if, for example, the dressing on a patient's central line was due to be changed, or if it was time for caregivers to re-evaluate whether medications given in the central line could be switched to oral formulations instead.

"The information was visible and easy to digest," said Deborah Franzon, MD, the study's senior author and a clinical associate professor of pediatrics and medical director of the hospital's pediatric intensive care unit. "We improved compliance with best-care practices and pulled information that otherwise would have been difficult to look for. It reduced busy-work and made it possible for the health-care team to perform their jobs more efficiently and effectively."

In addition to avoiding harm to patients, the intervention saved approximately $260,000 per year in health-care costs in the hospital's pediatric intensive care unit, the researchers estimated. Treating a single bloodstream infection from a central line costs approximately $39,000.

The researchers hope to expand the system to other uses, such as monitoring the recovery of children who have received organ transplants.

"The nice thing about this tool is that it's integrated into the electronic medical record, which we use every single day," Pageler said.

Added Franzon, "This system works like a GPS-based road map that pulls relevant information to the forefront, and helps guide decisions about how to get safely to the destination."

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